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	<title>复工申请平台</title>
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<head th:include="include :: header"></head>
<body class="">

<div class="container m-t">
	<br>
	<br>
	<h1 class="strong text-center">企业复工申请</h1>
	<br>
	<div class="col-xs-12">
		<hr style="width: 80%;">
	</div>
	<br>
	<br>
	<br>
	<div class="col-xs-12">
		<form id="signupForm" class="form-horizontal">
			<div class="form-group">
				<label for="inputEmail3" class="col-sm-2 control-label">企业名称</label>
				<div class="col-sm-7 col-sm-offset-1">
					<input type="text" class="form-control" id="companyName" name="companyName" placeholder="企业名称">
				</div>
			</div>
			<div class="form-group">
				<label for="inputEmail3" class="col-sm-2 control-label">企业统一社会信用代码</label>
				<div class="col-sm-7 col-sm-offset-1">
					<input type="text" class="form-control" id="companyOrgNum"  name="companyOrgNum" placeholder="企业统一社会信用代码">
				</div>
			</div>
			<div class="form-group">
				<label for="inputEmail3" class="col-sm-2 control-label">企业联系人身份证号</label>
				<div class="col-sm-7 col-sm-offset-1">
					<input type="text" class="form-control" id="idCardNum" name="idCardNum" placeholder="企业联系人身份证号">
				</div>
			</div>
			<br>
			<div class="form-group">
				<label for="inputEmail3" class="col-sm-2 control-label">企业申请指挥部</label>
				<div class="col-sm-7 col-sm-offset-1">
					<input type="text" class="form-control" id="companyApplyControId" name="companyApplyControId" placeholder="企业申请指挥部">
				</div>
			</div>
			<br>
			<br>
			<div class="form-group">
				<label for="inputEmail3" class="col-sm-2 control-label">企业所在省份</label>
				<div class="col-sm-7 col-sm-offset-1">
					<select class="form-control" id='id-w-city-1' name="privence"></select>
				</div>
			</div>
			<div class="form-group">
				<label for="inputEmail3" class="col-sm-2 control-label">企业所在市(州)</label>
				<div class="col-sm-7 col-sm-offset-1">
					<select class="form-control" id='id-w-city-2' name="city"></select>
				</div>
			</div>
			<div class="form-group">
				<label for="inputEmail3" class="col-sm-2 control-label">企业所在县（市）</label>
				<div class="col-sm-7 col-sm-offset-1">
					<select class="form-control" id='id-w-city-3' name = 'county'></select>
				</div>
			</div>
			<div class="form-group">
				<label for="inputEmail3" class="col-sm-2 control-label">企业所在地市行政区划分</label>
				<div class="col-sm-7 col-sm-offset-1">
					<input type="text" id="companyLocationCode" class="form-control" disabled name="companyLocationCode" placeholder="企业所在地市行政区划分">
				</div>
			</div>
			<br>

			<br>
			<div class="form-group">
				<label for="inputEmail3" class="col-sm-2 control-label">详细地址</label>
				<div class="col-sm-7 col-sm-offset-1">
					<input type="text" class="form-control" id="companyAddress" name="companyAddress" placeholder="详细地址">
				</div>
			</div>
			<br>
<!--			<div class="form-group">-->
<!--				<label for="inputEmail3" class="col-sm-2 control-label">返工总人数（包含司机）</label>-->
<!--				<div class="col-sm-7 col-sm-offset-1">-->
<!--					<input type="text" class="form-control" id="bakAllNum" name="bakAllNum" placeholder="返工总人数（包含司机）">-->
<!--				</div>-->
<!--			</div>-->
<!--			<br>-->
<!--			<div class="form-group">-->
<!--				<label for="inputEmail3" class="col-sm-2 control-label">企业所在地县指挥部审核意见（是/否）</label>-->
<!--				<div class="col-sm-7 col-sm-offset-1">-->
<!--					<input type="text" class="form-control" id="applyOpinion" name="applyOpinion" placeholder="企业所在地县指挥部审核意见">-->
<!--				</div>-->
<!--			</div>-->
<!--			<br>-->
<!--			<div class="form-group">-->
<!--				<label for="inputEmail3" class="col-sm-2 control-label">指挥部报送人员</label>-->
<!--				<div class="col-sm-7 col-sm-offset-1">-->
<!--					<input type="text" class="form-control" id="controPeopleId" name="controPeopleId" placeholder="指挥部报送人员">-->
<!--				</div>-->
<!--			</div>-->
			<br>
<!--			<div class="form-group">-->
<!--				<label for="inputEmail3" class="col-sm-2 control-label">区划</label>-->
<!--				<div class="col-sm-7 col-sm-offset-1">-->
<!--					<input type="text" class="form-control" id="aera" name="aera" placeholder="区划">-->
<!--				</div>-->
<!--			</div>-->
			<br>
			<div class="form-group">
				<label for="inputEmail3" class="col-sm-2 control-label">联系人</label>
				<div class="col-sm-7 col-sm-offset-1">
					<input type="text" class="form-control" id="connectPeople" name="connectPeople" placeholder="联系人">
				</div>
			</div>
			<br>
			<div class="form-group">
				<label for="inputEmail3" class="col-sm-2 control-label">联系电话</label>
				<div class="col-sm-7 col-sm-offset-1">
					<input type="text" class="form-control " disabled id="companyPhone" name="companyPhone" th:value="${companyPhone}" placeholder="联系电话">
				</div>
			</div>
			<br>
<!--			<div class="form-group">-->
<!--				<label for="inputEmail3" class="col-sm-2 control-label">申请返回时间</label>-->
<!--				<div class="col-sm-7 col-sm-offset-1">-->
<!--					<input type="date" class="form-control" id="workTime" name="workTime" placeholder="申请返回时间">-->
<!--				</div>-->
<!--			</div>-->
			<br>
<!--			<div class="form-group">-->
<!--				<label for="inputEmail3" class="col-sm-2 control-label">返岗类别</label>-->
<!--				<div class="col-sm-7 col-sm-offset-1">-->
<!--					<select class="form-control" name="workType">-->
<!--						<option value="1">执勤值守</option>-->
<!--						<option value="2">医疗救助</option>-->
<!--						<option value="3">交通保障</option>-->
<!--						<option value="4">生活保障</option>-->
<!--						<option value="5">志愿服务</option>-->
<!--						<option value="6">企业复工</option>-->
<!--						<option value="7">农业生产</option>-->
<!--					</select>-->
<!--				</div>-->
<!--			</div>-->

			<div class="form-group m-t-lg">
				<div class="col-sm-offset-3 col-sm-7">
					<button class="btn btn-default" id="btnSubmit">提交申请</button>
				</div>
			</div>
			<br>
			<br>
			<br>
			<br>
		</form>
	</div>


</div>
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